<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Blank Purchase Order</title>
<link rel="stylesheet" href="PurchaseOrderForm.css"/>
</head>
<body>
	<div id="htmlPurchaseOrderTitle">
		Procurement/Credit Card Request Form
	</div>
	<div id="htmlPurchaseOrderForm">		
		<table>
			<tr>
				<td class="shaded" style="width: 0.83in;">Request #</td>
				<td class="shaded" style="width: 1.54in;"></td>
				<td class="end" style="width: 2.78in;"></td>
				<td class="open" style="width: 2.76in; border-top-style: solid;"></td>
			</tr>
			<tr>
				<td class="shaded" style="border-bottom-style: solid; border-bottom-width: 3px;">Date:</td>
				<td id="htmlDate" class="thickBottom"></td>
				<td class="end" style="border-bottom-style: solid; border-bottom-width: 3px;">Credit Card<input type="checkbox"/> Procurement<input type="checkbox"/></td>
				<td class="open"></td>
			</tr>
		</table>
		<table>
			<tr>
				<td class="shaded" style="width: 2.44in;">1. Originator:</td>
				<td class="end" style="width: 2.75in;"><span id="htmlOriginator"></span></td>
				<td class="open" style="width: 2.71in;"></td>
			</tr>
			<tr>
				<td class="shaded">2. Deliver to:</td>
				<td class="end"><span id="htmlDeliverTo"></span></td>
				<td class="open"></td>	
			</tr>
			<tr>
				<td class="shaded">3. Priority:</td>
				<td class="end"><span id="htmlPriority"></span></td>
				<td class="open"></td>
			</tr>
			<tr>
				<td class="shaded">4. Date Required:</td>
				<td class="end"><span id="htmlDateRequired"></span></td>
				<td class="open"></td>
			</tr>
			<tr>
				<td class="shaded">5. Job Order Number:</td>
				<td class="end"><span id="htmlJobOrderNumber"></span></td>
				<td class="open"></td>
			</tr>
			<tr>
				<td class="shaded" style="border-bottom-style: solid; border-bottom-width: 3px;" >6. Estimated Cost:</td>
				<td class="end" style="border-bottom-style: solid; border-bottom-width: 3px;"><span id="htmlTotal"></span></td>
				<td class="open" style="border-bottom-style: solid; border-bottom-width: 3px;"></td>
			</tr>
		</table>
		<table>
			<tr>
				<td class="shaded" colspan="2" style="width: 5.08in;">7. Manufacturer and/or suggested Source(s):</td>
				<td class="end" style="width: 2.60in;">Sole Source Justification Attached<input type="checkbox"/></td>
			</tr>
			<tr>
				<td class="shaded"></td>
				<td style="height: 80pt; vertical-align: top;">
					<span id="htmlAddress"></span>
				</td>
				<td class="end" style="vertical-align: top;">
					Equipment Bar Code Required<input id="htmlEquipmentBarCode" type="checkbox"/>
					<br/>
					(Value over $2,500.00)			
				</td>
			</tr>
			<tr>
				<td class="phone">
					Phone:
				</td>
				<td class="phoneField">
					<span id="htmlPhone"></span>
				</td>
				<td class="phoneField" style="border-right-style: solid;"></td>
			</tr>
			<tr>
				<td class="fax">
					FAX:
				</td>
				<td class="faxField">
					<span id="htmlFax"></span>
				</td>
				<td class="faxField" style="border-right-style: solid;"></td>
			</tr>
		</table>
		<table class="shaded">
			<tr id="htmlItemsHeader" class="items">
				<td class="lineItem">Line Item #</td>
				<td class="part">Part/Model #</td>
				<td class="description">Description of material and/or Services</td>
				<td class="unitOfIssue">Unit of Issue</td>
				<td class="qty">Qty</td>
				<td class="unitPrice">Unit Price $</td>
				<td class="totalCost">Total Cost $</td>
			</tr>
		</table>
		<table id="htmlItems"></table>
		<table>
			<tr>
				<td style="width: 2.67in;">Signature</td>
				<td style="width: 2.4in;">Title</td>
				<td class="end" style="width: 2.64in;">Date</td>
			</tr>
			<tr>
				<td class="bottom" style="height: 0.32in;"></td>
				<td class="bottom" style="text-align:center;"><span id="htmlSignatureTitle"></span></td>
				<td class="end" style="border-bottom-style: solid; text-align:center;"><span id="htmlSignatureDate"></span></td>
			</tr>
		</table>
	</div>
</body>
</html>